1194734954 NPI number — MR. RAFAEL ARMANDO PALACIOS PHYSICIAN ASSISTANT

Table of content: MR. RAFAEL ARMANDO PALACIOS PHYSICIAN ASSISTANT (NPI 1194734954)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1194734954 NPI number — MR. RAFAEL ARMANDO PALACIOS PHYSICIAN ASSISTANT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PALACIOS
Provider First Name:
RAFAEL
Provider Middle Name:
ARMANDO
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
PHYSICIAN ASSISTANT
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
PALACIOS
Provider Other First Name:
RAFAEL
Provider Other Middle Name:
ARMANDO
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
PAC
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1194734954
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/17/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2412 SE 27TH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OCALA
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
34471-0703
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
352-867-7116
Provider Business Mailing Address Fax Number:
352-867-7116

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1431 SW 1ST AVE
Provider Second Line Business Practice Location Address:
OCALA REGIONAL MEDICAL CENTER, DPMT OF EMERGENCY MED
Provider Business Practice Location Address City Name:
OCALA
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
34471
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
352-351-7200
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/07/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363AM0700X , with the licence number:  PA9103290 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 363AM0700X , with the licence number: 04573 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)